NR 506 Week 2: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study

NR 506 Week 2: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study

NR 506 Week 2: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study

The case study depicts Mrs. Smith, who comes for an annual physical exam with an empty bottle of amoxicillin and requests a refill. She had a refill a week ago, and the FNP’s name is indicated on the label as the prescriber. The patient mentioned that she had talked with Stephanie, the medical assistant. However, the medical assistant did not discuss it with the FNP or other NPs. This paper will discuss the ethical and legal implications for each member and how to prevent similar illegal behavior in the future.

Potential ethical and legal implications for each of the following practice members:

Medical assistant

All medical assistants must have some degree of physician supervision when prescribing medications. Some states also have limitations on the medications that medical assistants can prescribe (Figueroa Gray et al., 2021). The medical assistant faces legal implications for prescribing a drug without supervision from a physician or NP and writing another practitioner’s name when prescribing without their knowledge. Stephanie faces the risk of losing her practicing license or being fined if she prescribed a drug that is restricted for medical assistants.

Nurse Practitioner

An NP has an ethical duty in prescribing, selecting an appropriate medication, providing patients with information, warnings, and instructions about their medication, and monitoring the patient regularly. The NP may face ethical implications if the drug prescribed with the FNP’s name harms the patient. In prescribing, the NP has a moral duty to do good (beneficence) and avoid harm to the patient (nonmaleficence) (Vaismoradi et al., 2021). Thus, the NP may face fines or lose his license if the Amoxicillin causes adverse drug reactions.

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Medical Director

The medical director may also face ethical consequences for failing to ensure that employees in the organization adhere to their prescriptive duties. The director may face fines for failing to supervise the employees’ conduct when attending to patients. Besides, the director failed to ensure that medical assistants were working as per their scope of practice.


            The practice risks facing legal actions for healthcare providers failing to adhere to their scope of practice when providing patient care. The practice may face ethical consequences for corporate negligence since providers prescribe patients medications without prescriptive authority and supervision (Vaismoradi et al., 2021). Legal consequences include fines, temporarily losing the operating license, or being closed permanently.   

What strategies would you implement to prevent further episodes of potentially illegal behavior? 

The first strategy will be to organize continuous medical education (CME) to educate the healthcare providers on their scope of practice. It will be crucial for each profession to fully understand their scope of practice and that of the other professions. In addition, I would develop a policy to guide the employees in the practices on the actions that will be taken if they do not adhere to their scope of practice.

What leadership qualities would you apply to effect a positive change in the practice?

The leadership qualities that I will apply to create positive change in the practice include communication, coaching, and decision-making. Communication is a vital leadership skill of conveying information to individuals in a manner they can understand and also involves listening to employees (Walk, 2023). Coaching is the ability of the leader to guide others to improve. I would apply coaching skills to empower the employees and improve their engagement and accountability in patient care. Furthermore, I will need to employ strong decision-making skills that entail evaluating options, assessing the advantages of each, and committing to the option that can provide the most value to patients, providers, and practice.

NR 506 Week 2: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study References

Figueroa Gray, M., Coleman, K., Walsh-Bailey, C., Girard, S., & Lozano, P. (2021). An Expanded Role for the Medical Assistant in Primary Care: Evaluating a Training Pilot. The Permanente journal25, 20.091.

Vaismoradi, M., Jordan, S., Logan, P. A., Amaniyan, S., & Glarcher, M. (2021). A Systematic Review of the Legal Considerations Surrounding Medicines Management. Medicine (Kaunas, Lithuania)57(1), 65.

Walk, M. (2023). Leaders as change executors: the impact of leader attitudes to change and change-specific support on followers. European Management Journal41(1), 154-163.

Good afternoon Dr.T and Class,

Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study.

As a family nurse practitioner working in a busy primary care clinic, The NP understands the importance of delivering care by all applicable laws and ethical standards. However, in a busy practice, ensuring everyone is familiar with and adhering to the established protocols and procedures can be difficult. In this case study, a medical assistant may have participated in unlawful conduct by writing prescriptions for drugs without the necessary permission or authorization, raising questions regarding the possible ethical and legal repercussions for all practice members.

Potential Ethical and Legal Implications for Each of The Following Practice Members.

For the medical assistant:

  • Ethical implications. Without the consent or knowledge of the practitioner in charge of the patient’s treatment, Stephanie wrote a prescription for the patient, which might be considered as a violation of patient confidentiality and trust. She may also have jeopardized the patient’s well-being due to her conduct.
  • Possible legal ramifications. Stephanie may have broken local, state, and federal laws regarding the possession and distribution of prescription drugs. Possible penalties include monetary fines, loss of driving privileges, and even criminal prosecution (Miller & Nicolas, 2022).

For the nurse practitioner:

  • Ethical implications. The nurse practitioner must report Stephanie’s behavior and address any training or supervision issues that led to the incident. Failing to take appropriate action may violate the ethical principles of beneficence and non-maleficence (DeCamp & Snyder Sulmasy, 2021).
  • Possible legal ramifications. Suppose it is shown that the nurse practitioner did not properly supervise Stephanie or did not disclose the occurrence as required by law. In that case, the nurse practitioner might be held legally responsible.

For the medical director:

  • Ethical implications. The medical director is responsible for implementing measures to ensure all employees are properly trained and supervised to avoid future accidents like this one. Not doing so might be a breach of duty and accountability, which are fundamental to ethics. (DeCamp & Snyder Sulmasy, 2021)
  • Legal ramifications. If employees of the facility are discovered to have violated state or federal regulations pertaining to dispensing prescription drugs, the medical director may be held accountable.

Practice as a whole:

  • Ethical implications. Care for patients must always be delivered according to the highest professional and ethical standards, and the whole practice must make that happen. DeCamp and Snyder Sulmasy (2021) state that failure to do so may be a breach of ethical norms related to professionalism, honesty, and trustworthiness.
  • Possible legal ramifications. Suppose it is determined that the practice does not provide enough training and supervision for its employees. In that case, the practice may be held accountable for breaching state and federal laws concerning prescription drugs. In addition, the practice’s reputation may be harmed if patients stop having faith in the quality of treatment they receive there (Miller & Nicolas, 2022).

To Prevent Further Episodes of Potentially Illegal Behavior, The Following Strategies Could Be Implemented.

  • Education and Training. Involving all employees in ongoing training and education on the legal and ethical considerations involved in medication prescribing, patient confidentiality, and adhering to standard operating procedures. Some ways to accomplish this goal include holding routine staff meetings and workshops and making relevant literature and guidelines easily accessible.
  • Encouraging open communication between care providers, staff members, and patients facilitates better care coordination and helps prevent misunderstandings (Patient Safety Network, 2021).
  • Including disciplinary action, termination of employment, and reporting illegal activity to appropriate authorities as possible consequences for breaking established protocols and procedures.

Leadership Qualities That Could Be Applied to Effect a Positive Change in The Practice Include:

  • Have a clear vision. Formulating a long-term strategy for the business that prioritizes ethical and legal observance, excellent patient care, and a supportive workplace culture.
  • Transformational leadership: fostering a culture of responsibility and continuous development and inspiring employees to take the initiative, think creatively, and dedicate themselves to the practice’s success (Texas A&M International University, 2021).
  • Emotional Intelligence. Fostering a healthy and supportive work atmosphere by displaying empathy, self-awareness, and social skills while interacting with colleagues and patients.



DeCamp, M., & Snyder Sulmasy, L. (2021). Ethical and Professionalism Implications of Physician Employment and Health Care Business Practices: A Policy Paper From the American College of Physicians. Annals of Internal Medicine174(6), 844–851. to an external site.

Miller, A. E., & Nicolas, S. (2022). Federal Regulation of Medication Dispensing. In StatPearls [Internet]. StatPearls Publishing. to an external site.

Patient Safety Network. (2021). Approach to Improving Patient Safety: Communication. Psnet.ahrq.gov to an external site.

Texas A&M International University. (2021). How transformational leadership in healthcare impacts positive patient health outcomes. Texas A&M International University Online. ‌

Within the case study presented, there are various potential ethical and legal implications for each of the practice members involved. The role of a medical assistant has evolved within the interdisciplinary healthcare team, taking on roles and responsibilities including taking vital signs, collecting patient data, preparing lab specimens, and scribing (Gray et al., 2021). However, Stephanie, the medical assistant in the case study, performed outside of her scope of practice when prescribing the amoxicillin to Mrs. Smith. Medical assistants do not have prescriptive authority, nor have they undergone the required education and certification to make safe decisions on medication usage, dosage, and side effects. Without the proper training, Stephanie broke both ethical and legal practices by potentially causing unintended patient harm and practicing outside of her boundaries. Stephanie could face numerous legal charges for impersonating the nurse practitioner’s signature and endorsing prescriptive authority on the medication script. Consequences could include losing her medical assistant license, termination of her position, and inability to work within and outside of the state of practice.

The nurse practitioner in the case study is also at fault, as part of the nurse practitioner’s responsibility is to oversee the work of licensed and unlicensed subordinates. Delegation of tasks is rooted in level of education, skills, and experience (Beckett et al., 2021). Although the nurse practitioner in the case study was unaware of the script, delegation of prescriptive duties without prescriptive authority is unethical and illegal. The nurse practitioner is the only person legally allowed to use the DEA number, transitioning the case into a patient protection and negligence issue as well. The medical assistant put both her own license and the nurse practitioner’s license at stake, as the patient was not assessed, evaluated, and medically cleared for the necessity and suitability of the medication towards her treatment plan. While the patient was unharmed, the quality of care, medical obligations to beneficence and nonmaleficence, scope of practice, and medical integrity are ethical and legal complications to discuss and consider after the incident. 

The medical director is faced with both ethical and legal dilemmas, concerning the patient’s safety, disciplinary actions for the medical assistant and nurse practitioner, and violations against state specific and federal laws. In a similar way, the practice must take disciplinary action in anticipation of lawsuits and involvement of medical boards. The medical director is responsible for the actions of practice and to uphold all medical, ethical, and health standards in accordance with state and federal policies. Thus, the medical director must follow protocol in disciplining both employees. The practice must be evaluated by stakeholders, policymakers, and healthcare organizations to determine criminal and financial liabilities within the case (Dahlawi et al., 2021). Both the medical director and the practice must be willing to recognize the flaws within the events that transpired and accept responsibility to ensure that all parties involved are taken care of and exact policies in place to prevent future occurrences. 

To prevent further episodes of potentially unethical and illegal behavior, I would implement educational workshops and development for all staff members. The healthcare system is reliant on teamwork to achieve high quality of care and improved health outcomes. However, when working in high stress environments, scope of practice and practice boundaries may become ambiguous – especially without uniformity in the roles and responsibilities of the various members of the interprofessional healthcare team. Thus, implementation of educational workshops to outline scope of practice would facilitate the clarification of practice boundaries and alleviate future practice incidents. Scope of practice is dependent on 8 factors: education, competency, professional identity, role confusion, legislation and regulatory policies, organizational structure, and financial, professional, and personal factors (Wiggins et al., 2022). The workshops would review the 8 factors in addition to guidelines and policies within the established practice. The policies would be sent out electronically to all employees, as well as displayed around the office to avoid any further confusion. 

In reviewing the events that led up to the incident aforementioned in the case study, I would instill an open door policy to effect a positive change within the practice. Leadership qualities I hope to lead by example include teamwork, effective communication, critical thinking, and integrity (Brunt & Bogdan, 2021). I would want all members in the practice to feel comfortable asking questions and communicating about problems or decisions. I would strive for a culture where all members in the practice feel respected, valued, and heard. In that way, an essential part of being a leader encompasses introspection and reflection. Along with brainstorming ways to foster a positive work culture and environment, I would take time to look within myself to observe any biases and prejudices I hold that could be affecting my views, outlook, and performance. In that way, I can put my best foot forward and be open to any comments, suggestions, concerns, and changes brought up within the practice.


Beckett, C. D., Zadvinskis, I. M., Dean, J., Iseler, J., Powell, J. M., & Buck‐Maxwell, B. (2021). An integrative review of team nursing and delegation: Implications for nurse staffing during COVID‐19. Worldviews on Evidence‐Based Nursing18(4), 251-260.

Brunt, B. A., & Bogdan, B. A. (2021). Nursing Professional Development Leadership.

Dahlawi, S., Menezes, R. G., Khan, M. A., Waris, A., & Naseer, M. M. (2021). Medical negligence in healthcare organizations and its impact on patient safety and public health: a bibliometric study. F1000Research10.

Gray, M. F., Coleman, K., Walsh-Bailey, C., Girard, S., & Lozano, P. (2021). An expanded role for the medical assistant in primary care: evaluating a training pilot. The Permanente Journal25.

Wiggins, D., Downie, A., Engel, R. M., & Brown, B. T. (2022). Factors that influence scope of practice of the five largest health care professions in Australia: a scoping review. Human Resources for Health20(1), 1-13.

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